Oppositional Defiant Disorder (ODD)
Officially, the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) defines oppositional defiant disorder as follows:
Arecurrent pattern of negative, hostile, authority-defying behaviors manifested by at least four of the following criteria for at least six months, and they must be present in at least one context outside of sibling relationships:
- Often loses composure, loses control of anger.
- Often argues with adults or authority figures.
- Often actively defies rules and demands, or refuses to comply with adult rules and demands.
- Often deliberately seeks to annoy, disturb or provoke others.
- Often blames others for own mistakes or bad behavior.
- Is often easily annoyed and irritated by others.
- Often moody or resentful.
- Is often spiteful or vindictive (vengeful).
It's important to note that these diagnostic criteria provide a framework for assessing and diagnosing Oppositional Defiant Disorder (ODD), but they must be interpreted within the overall clinical context of each child.
Oppositional and defiant behaviors can be caused by a variety of factors, and diagnosis must be based on a thorough assessment of the child's developmental history, social, academic and family functioning, as well as the specific symptoms observed and their cause.
Oppositional Defiant Disorder or oppositional behaviors: The distinction is important!
Attention parents: the vast majority of children described as "difficult" don't have OPPOSITIONAL DEFIANT DISORDER, but OPPOSITIONAL BEHAVIORS. The difference can be explained as follows: Oppositional Defiant Disorder (ODD) is thought to be innate, and part of a child's developing personality traits.
It can be viewed as a set of personality traits intrinsic to the child, whereby he or she seeks to be in control rather than to please the adult. These personality traits also lead to a natural tendency to be irritable rather than playful, and impatient rather than persevering.
The child with a real oppositional disorder doesn't oppose impulsively, he opposes and provokes thoughtfully and with planning. This child doesn't hurt and wound by accident in a fit of rage, he injures deliberately.
He therefore feels no remorse for his oppositional, provocative and vengeful behavior, nor does he worry about having broken his bond with his parents, since this child is not in search of affection and the parent-child bond, but in search of control.
Conversely, when we speak of oppositional attitudes without oppositional disorder, we're referring to reactions that are not rooted in the child's personality or usual way of reacting, but rather are reflexes that the child adopts in response to something.
Often, this "something" generates distress or unease in the child, making him or her irritable and less able to cope with the frustrations of daily life. For example, a child may adopt oppositional behaviors:
- ... in reaction to the fact that he feels his parents prefer his brothers/sisters who are better at school, ice hockey or piano, for example. This child feels that he or she cannot find his or her place among the siblings, and in the hearts of his or her parents. They feel distressed and adopt unpleasant behaviors to be seen and heard.
- ... in response to difficult life situations. For example, if he's being bullied, or if she's concerned about conflicts between her parents, or if he's experiencing academic failures that undermine his self-esteem.
- ... because he / she experiences anxiety and try to avoid situations that generate this anxiety, such as going to school, seeing friends, or studying for an exam.
Oppositional behaviors (without oppositional disorder) can also occur in children who lack the neurological capacity to filter their reactions and manage their emotional outbursts. Children with ADHD or Gilles-de-la-Tourette Syndrome have immature frontal brain areas, which normally enable inhibition and self-control.
Their impulsiveness leads them to overreact to everyday frustrations, to generate sometimes explosive conflicts, and to act or speak out of impulsive irritation.
When they come back to their senses, these children blame themselves, devalue themselves and worry that they've broken their bond with their parent. These children seek to please and have a strong bond with the adult, but they lack control over their excess fury.
The following table summarizes the difference between Oppositional Defiant Disorder (ODD) and oppositional behaviors resulting from other factors:
Assessment and diagnosis
At CERC, the assessment is carried out by a neuropsychologist and includes the following steps:
- Anamnesis: this is a one-hour meeting during which we take a complete history of the development and current life situation of the child or adult we are assessing. This meeting usually takes place remotely, by videoconference.
- Evaluation:Neuropsychological evaluation assesses the integrity of various brain functions. It takes place in an office, over a full day (5 hours) or two half-days for children under 8. The person being evaluated will be given various tests (adapted to their age) measuring all cognitive functions (IQ, reasoning, logic, memory, attention/concentration, etc.). Often, a profile of personality traits and emotional / psycho-affective feelings is also drawn up, to help the professional fully grasp the various issues and forces at play in the day-to-day life of the person being assessed.
- Test correction and report writing : This part of the work carried out by the neuropsychologist or psychologist takes place in the weeks following the assessment, without the client being present. The results of the tests administered are compared with expected averages and used to assign a percentile rank (rank among 100 people in a reference group) to the various cognitive functions of the person being assessed. A detailed, graphically illustrated report is produced to explain the results.
- Debriefing session : Three to four weeks after the assessment, the neuropsychologist (or psychologist) meets with the parents or adult being assessed, to explain the results and provide a copy of the report.
Interventions
One of the most effective interventions for managing a child's oppositional behaviour is to equip parents to react appropriately to these attitudes, and to prevent such reactions from occurring in the first place.
The parenting coaching offered at CERC aims to do just that. Parents often unwittingly contribute to oppositional dynamics and/or amplify children's anger through their interventions.
The idea is to know how to maintain a framework and authority at home, without positioning ourselves as adversaries to our children and entering into a dynamic of argumentation and crises. Parenting coaching sessions are offered by our neuropsychologists and psychoeducators.
Our psychoeducation professionals can also follow your child's progress, helping him to manage his emotions, verbalize his requests in the right way, or interact socially with his peers.
